CUSTOMER STORY
How Enhanced Revenue Cycle Insights Improved Hospital Operations and Metrics
Background
Hospitals of all sizes are feeling the squeeze of smaller margins and staff shortages that require them to do more with less.
Critical access hospitals may be smaller facilities, but they adhere to the same standards of care as large health centers. And unfortunately, they face many of the same administrative hassles.
Megan Weaver is the Business Office Director at Mason District Hospital, a 25-bed critical access hospital in Havana, Illinois. As an 18-year veteran, she has a good understanding of what works and what doesn’t in a billing office. As denial rates and other RCM issues started creeping up, she knew it was time for a change.
Clearinghouse Complications
Weaver remembers when the electronic billing market was booming and how the product they were using for their clearinghouse just wasn’t working.
“It just didn’t break down and give me the information like I wanted to see it,” she said. “And you couldn’t build in billing rules pertaining to certain CPT codes or certain insurance companies.”
Instead of making daily tasks faster and easier, the application made the staff do most of the legwork to create clean, accurate claims. Weaver said that the ability to create customized payer rules and streamline processes was a key selling point of Inovalon’s RCM Intelligence™.
“As a critical access hospital, there are a lot of different rules and regulations we have to follow,” said Weaver. “And certain insurance companies just want things their own way.”
Though things were going well with RCM Intelligence, hospital executives discovered along the way that their internal EHR provided clearinghouse capabilities. They suggested eliminating RCM Intelligence to use their EHR, assuming it would simplify the process and provide cost savings. Weaver agreed to try it for one year, to see if it would work the way she wanted and generate the reports she needed. And according to her, quite simply – it didn’t.
So they switched back to RCM Intelligence.
“As a critical access hospital, there are a lot of different rules and regulations we have to follow, and certain insurance companies just want things their way.”
Megan WeaverBusiness Office Director, Mason District Hospital
Reporting and Analytics to the Rescue
In addition to utilizing clearinghouse functions, the hospital uses the reporting features to monitor eligibility, denials, and monthly A/R.
The scorecards are another great feature. Weaver regularly uses the denials scorecard to report results to the hospital’s board of directors. She can even drill down into individual or departmental performance metrics to determine where breakdowns are happening in the claim life cycle (patient access vs. coding, for example). Not only can these metrics help identify ways to avoid denialcausing errors, they can also determine whether continuing education is needed, and help with annual employee evaluations.
Weaver’s also taken a creative approach, developing performance contests for staff. Because she has such a small team, she didn’t want to pit them against one another, so she incentivizes them to work together to meet certain goals as a team.
“Our denial rate has definitely dropped and eligibility has improved,” said Weaver.
Easy to Use, Better for Staff
For an application to be valuable, it should be easy to use and should simplify tasks and processes, helping staff do what they do better or faster. Weaver credits the creators of RCM Intelligence, saying “[They] did an excellent job of building the system and knowing what financial/billing people go through day in and day out.”
“My staff love RCM Intelligence. It’s very easy to maneuver; to move screen to screen. It’s a very easy workflow for them.”
Megan WeaverBusiness Office Director
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